Fertility and Chronic Illness: How to Build a Family When You’re Managing a Long-Term Condition

Trying to get pregnant while managing a chronic illness isn’t just about timing ovulation or tracking basal body temperature. It’s about balancing medications, energy levels, flare-ups, and the emotional weight of wondering if your body can carry a child-without compromising your health. Thousands of people with conditions like lupus, type 1 diabetes, Crohn’s disease, multiple sclerosis, and rheumatoid arthritis are choosing parenthood. And they’re doing it successfully. But it’s not a straight path. It takes planning, communication, and sometimes, hard choices.

Chronic Illness Doesn’t Mean Infertility-But It Changes the Rules

Having a long-term health condition doesn’t automatically mean you can’t get pregnant. Many people with chronic illnesses conceive naturally. But the disease itself, or the drugs used to control it, can affect fertility, pregnancy safety, or both.

For example, women with uncontrolled lupus have a higher risk of miscarriage and preterm birth. Men with type 1 diabetes may experience reduced sperm quality if blood sugar isn’t well managed. People with Crohn’s disease in active flare may find it harder to conceive, and some medications like methotrexate are outright unsafe during pregnancy.

The key isn’t avoiding parenthood-it’s adjusting the path. Fertility isn’t blocked; it’s complicated. And that complexity needs to be addressed before you start trying.

Start With Your Medical Team-Not Just Your OB-GYN

Most people see their OB-GYN first when thinking about pregnancy. But if you have a chronic illness, your rheumatologist, endocrinologist, gastroenterologist, or neurologist needs to be at the table too.

Why? Because your fertility plan must align with your disease management plan. A medication that keeps your MS in remission might harm a developing fetus. A blood sugar target of 7% might be fine for daily life-but for pregnancy, your doctor will push you to 6% or lower.

Studies from the UK’s National Institute for Health and Care Excellence show that people who plan pregnancy with their specialist teams have 40% fewer complications than those who don’t. That’s not a small number. It’s life-changing.

Start the conversation early. Ideally, six to twelve months before you want to conceive. Bring your full medication list. Ask: Which drugs are safe? Which need to be switched? What’s the safest time to get pregnant based on my disease activity?

Medication Switches: What’s Safe, What’s Not

Some drugs are fine during pregnancy. Others are not. And switching isn’t always simple.

• Methotrexate (used for RA, psoriasis, Crohn’s): Must be stopped at least three months before trying. It causes severe birth defects.
• Biologics like Humira or Enbrel: Many are considered low-risk during pregnancy. Some can be continued into the second trimester, but often stopped before delivery to avoid immune effects on the baby.
• ACE inhibitors for high blood pressure: Dangerous in pregnancy. Switched to labetalol or methyldopa.
• Insulin: Safe. But dosage needs constant adjustment as pregnancy progresses.
• Antidepressants like SSRIs: Often continued, but risks vs. benefits are weighed case by case.

There’s no universal list. What’s safe for one person isn’t safe for another. Your condition’s severity, your age, your treatment history-all matter. That’s why a specialist review is non-negotiable.

Timing Matters More Than You Think

Trying to get pregnant during a flare-up is like trying to run a marathon with a sprained ankle. Your body is already under stress. Adding pregnancy on top increases risks for both you and the baby.

Experts recommend aiming for at least three to six months of stable disease control before conception. That means:

• No major flares in the last six months
• Medications are at their lowest effective dose
• Lab markers (like CRP, HbA1c, or fecal calprotectin) are in target range

For someone with type 1 diabetes, that might mean HbA1c under 6.5%. For someone with lupus, it could mean no protein in the urine and normal complement levels. These aren’t just numbers-they’re safety thresholds.

Don’t rush. Waiting six months for stability can mean the difference between a high-risk pregnancy and a manageable one.

Fertility Treatments: Are They an Option?

If you’ve been trying for six months (or three, if you’re over 35) without success, fertility treatment might be next. But chronic illness adds layers.

IVF requires hormone injections, which can trigger flares in autoimmune conditions. Some clinics won’t proceed unless your disease is stable. Others will, but with extra monitoring.

For people with PCOS and type 2 diabetes, metformin may improve ovulation. For those with endometriosis and Crohn’s, surgery might be needed before IVF. Each case is unique.

Don’t assume IVF is off the table. But do assume you’ll need a team that includes a reproductive endocrinologist who understands your condition. Ask clinics: How many patients with [your condition] have you helped conceive? If they don’t have experience, find someone who does.

Emotional Toll: The Hidden Barrier

Physical challenges get attention. The emotional ones? Not so much.

Feeling like your body is betraying you-both because of your illness and your fertility struggles-is isolating. You might feel guilty for wanting a child when you’re already managing so much. Or angry that others seem to conceive easily while you’re counting pills and appointments.

Studies show that people with chronic illness trying to conceive report higher levels of anxiety and depression than those without. That’s not weakness. It’s a normal response to an unfair situation.

Support matters. Find a therapist who understands chronic illness. Join a group like Fertility Network UK or the Lupus Foundation’s parenting forum. You’re not alone. And you don’t have to carry this alone.

Pregnancy and Beyond: What to Expect

If you get pregnant, you’ll likely be classified as high-risk. That means more scans, more blood tests, and more specialists involved. But it doesn’t mean you can’t have a joyful, healthy pregnancy.

Many women with well-controlled lupus deliver healthy babies. Men with type 1 diabetes become involved, present fathers. People with MS go on to raise children, even if they need help with mobility later.

Postpartum is another challenge. Sleep deprivation can trigger flares. Medications may need to be adjusted again, especially if breastfeeding. Some drugs are safe while nursing-others aren’t. Your team should have a plan for this phase too.

Having a baby doesn’t mean your illness disappears. But it doesn’t have to stop you from being a parent.

Your Path Is Different-And That’s Okay

There’s no one-size-fits-all roadmap for parenthood when you have a chronic illness. Some people conceive naturally after a year of planning. Others need IVF. Some adopt. Some choose child-free living-and that’s valid too.

What matters isn’t the path. It’s that you’re making the choice with full information, support, and care.

You’re not broken. You’re not behind. You’re navigating a system that wasn’t built for people like you. But you’re doing it anyway. And that takes courage.

Start with your doctors. Get your meds sorted. Give yourself time. Build your support team. And remember: your worth as a future parent isn’t measured by how easy the journey was. It’s measured by how deeply you wanted it-and how hard you fought for it.